425802105-9-1-2021-29-AS-KBUY-C7BQQ3-20210929122140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802105
Report Date: 09/01/2021
Date Signed: 09/01/2021 04:55:02 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2021 and conducted by Evaluator Toan Luong

COMPLAINT CONTROL NUMBER: 29-AS-20210813153357

FACILITY NAME:	PEOPLE'S CARE LAKE MARIE		FACILITY NUMBER:	425802105
ADMINISTRATOR:	CHARLOTTE ACOSTA HILL		FACILITY TYPE:	735
ADDRESS:	2186 LAKE MARIE DR		TELEPHONE:	(805) 314-2093
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY:	4	CENSUS: 4	DATE:	09/01/2021
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Lacey Hemeon, House Manager		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff verbally abused client.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 9/1/21 at 2:45 PM, LPA Luong conducted an unannounced complaint visit to the facility to deliver final findings of the complaint allegation. LPA met with House Manager Lacey Hemeon and explained the purpose of the visit.
Allegation #1: Facility staff verbally abused client.
LPA conducted interviews with staff on 8/19/21 at 11:16 AM, 11:33 AM, and 11:46 AM. LPA interviewed clients on 8/19/21 at 11:09 AM 12:39 PM, and 12:56 PM. Interviews with clients reveals that clients are fearful of other clients. Clients gave accounts of client on client aggression and arguments. Clients did not describe any verbal abuse from staff when inquired. Staff interviews reveals that clients do not get along with each other and would have to be separated by staff when arguments arise. Clients would need to separate out of line of sight and staff provided incidents where clients were aggressing towards each other. Staff did not give an account of verbal abuse from other staff. At this time this allegation is deemed to be unsubstantiated.
Exit interview conducted, report emailed to administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Toan Luong
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2